American Nonsmokers’ Rights Foundation

All ANRF recipient costs, including administration, fundraising, data, education and grants; excludes the separate 501(c)(4). P must reflect portfolio allocation, paid-contract substitution and next-dollar capacity. Additional employer/public enforcement resources are separate social costs; no claim they are free.

P and N count previously exposed nonsmokers across all supported geography before allocation. The conditional g=0.99 then allocates resulting health benefits to residents of the 50 states and DC, including tribal residents. Territories, international beneficiaries and foreign tourists are excluded from the resulting USA total, not pre-excluded from P. g is a judgment, not an observed health-weighted share.

Q_USA=(G/C)*P*[(rD*L+rM*qM)*z*w*t-h]*g; G=10000 normalization. P=sum_j N_j*delta_p_j*a_j*e_j*sum_t retention_jt/(1.03)^t, after ordinary-funding additionality and portfolio allocation. N_j is previously exposed nonsmoking residents across all supported geography, before applying g; delta_p is net adoption/maintenance/acceleration probability; a is charitable-recipient causal share if delta_p is coalition-level; e is enforcement. Do not discount the same attribution twice. Cost per 10=10G/Q_USA if positive.

G

10000 USD normalization (judgment). Model disclosure only.

C

3927527 USD annual full recipient cost (observed). 2024 gross recipient expense; no netted direct costs identified. [anrf-tax24]

P

10000 additional attributable discounted protected person-years per annual-cost equivalent (judgment). We choose 10,000 net additional discounted protected person-years per annual cost equivalent. A planning construction is 50,000 exposed people × 50% probability of changing protection × 20% charitable contribution × 50% funding response × 90% enforcement × 4.58 discounted years: about 10,300, rounded to 10,000. These are judgments, not an observed pipeline. National reach and service cuts support a possible funding response; cumulative national coverage receives no credit.

P-probe

10000 protected person-years (judgment). Illustrative yield, not anchored to cumulative national coverage.

rD

0.001 unexposed fatal coronary events/person-year (judgment). Hypothetical worker baseline; requires age/sex/clinical calibration, not a measured ANRF cohort. [cdc-shs]

rM

0.002 unexposed nonfatal coronary events/person-year (judgment). Non-overlapping morbidity rate; not deaths or all cardiac admissions. [cdc-shs]

z

0.25 relative excess coronary risk (judgment). CDC reports 25–30% coronary disease excess with SHS; applying it to fatal and nonfatal worker events separately is an explicit extrapolation, not observed trial effect. [cdc-shs]

w

0.5 fraction of SHS excess risk removed (judgment). Workplace policy does not remove home/other exposure; not a linear conversion from measured cotinine. [allwright-worker]

t

0.5 latency and causal-transport factor (judgment). Discounts immediate/full reversal of long-term risk and conflicting US policy estimates. [hoekstra-bans] [shetty-bans]

L

10 discounted QALYs lost per premature coronary death (judgment). Hypothetical age/morbidity-weighted remaining health; not full life expectancy.

qM

0.3 discounted QALYs lost per nonfatal coronary event (judgment). Includes acute and sustained morbidity without duplicating fatal cases.

h

0.00002 QALY downside per protected person-year (judgment). Illustrative allowance for displacement/enforcement harms; not measured incidence or a validated bound.

g

0.99 USA resident health share (judgment). Predominantly domestic recipient scope, but territories/foreign benefits need a health-weighted audit. [anrf-policy26]

Best estimate — explicit judgment: Cost: $10K; USA QALYs: 0.01619530559560762; all-population QALYs: 0.016358894541017795. {"C":3927527,"P":10000,"rD":0.001,"rM":0.002,"z":0.25,"w":0.5,"t":0.5,"L":10,"qM":0.3,"h":0.00002,"g":0.99}; P is a hypothetical net additional discounted protected person-year yield at the full annual recipient cost scale, not observed coverage. We choose 10,000 net additional discounted protected person-years per annual cost equivalent. A planning construction is 50,000 exposed people × 50% probability of changing protection × 20% charitable contribution × 50% funding response × 90% enforcement × 4.58 discounted years: about 10,300, rounded to 10,000. These are judgments, not an observed pipeline. National reach and service cuts support a possible funding response; cumulative national coverage receives no credit.

10,000 net protected person-years at annual cost scale: Cost: $10K; USA QALYs: 0.01619530559560762; all-population QALYs: 0.016358894541017795. {"C":3927527,"P":10000,"rD":0.001,"rM":0.002,"z":0.25,"w":0.5,"t":0.5,"L":10,"qM":0.3,"h":0.00002,"g":0.99}; P is a hypothetical net additional discounted protected person-year yield at the full annual recipient cost scale, not observed coverage.

100,000 net protected person-years; same health assumptions: Cost: $10K; USA QALYs: 0.16195305595607615; all-population QALYs: 0.16358894541017793. {"C":3927527,"P":100000,"rD":0.001,"rM":0.002,"z":0.25,"w":0.5,"t":0.5,"L":10,"qM":0.3,"h":0.00002,"g":0.99}; P is a hypothetical net additional discounted protected person-year yield at the full annual recipient cost scale, not observed coverage.

High-yield and higher-risk conditional test, not a bound: Cost: $10K; USA QALYs: 2.8924689760248627; all-population QALYs: 2.921685834368548. {"C":3927527,"P":250000,"rD":0.002,"rM":0.003,"z":0.3,"w":0.75,"t":0.8,"L":12,"qM":0.5,"h":0,"g":0.99}; P is a hypothetical net additional discounted protected person-year yield at the full annual recipient cost scale, not observed coverage.

Low-risk implementation with adverse net result: Cost: $10K; USA QALYs: -0.00003982658807947087; all-population QALYs: -0.00004022887684795038. {"C":3927527,"P":1000,"rD":0.0002,"rM":0.0005,"z":0.1,"w":0.2,"t":0.2,"L":5,"qM":0.1,"h":0.00002,"g":0.99}; P is a hypothetical net additional discounted protected person-year yield at the full annual recipient cost scale, not observed coverage.

No additional protection: Cost: $10K; USA QALYs: 0; all-population QALYs: 0. {"C":3927527,"P":0,"rD":0.001,"rM":0.002,"z":0.25,"w":0.5,"t":0.5,"L":10,"qM":0.3,"h":0.00002,"g":0.99}; P is a hypothetical net additional discounted protected person-year yield at the full annual recipient cost scale, not observed coverage.

Only nonfatal cardiac pathway: Cost: $10K; USA QALYs: 0.000441117273032114; all-population QALYs: 0.0004455730030627414. {"C":3927527,"P":10000,"rD":0,"rM":0.002,"z":0.25,"w":0.5,"t":0.5,"L":10,"qM":0.3,"h":0.00002,"g":0.99}; P is a hypothetical net additional discounted protected person-year yield at the full annual recipient cost scale, not observed coverage.

Counterfactual: Count only protection newly caused or preserved by additional unrestricted support relative to employers' voluntary policies, laws already scheduled, public enforcement, other nonprofits and paid contracts. P can be zero. If counting acceleration, count only the years gained, not lifetime policy benefits.

Attribution: P is an explicitly unresolved net causal output, not total laws, covered population, press coverage, shareholder-report votes or the affiliate's lobbying success. Coalition contribution, enforcement, reversal and geographic attribution must be case-specific.

We choose 10,000 net additional discounted protected person-years per annual cost equivalent. A planning construction is 50,000 exposed people × 50% probability of changing protection × 20% charitable contribution × 50% funding response × 90% enforcement × 4.58 discounted years: about 10,300, rounded to 10,000. These are judgments, not an observed pipeline. National reach and service cuts support a possible funding response; cumulative national coverage receives no credit. Zero and adverse outcomes remain possible; the quantified pathway is not a complete portfolio valuation.

Sensitivity

• The conditional clinical yield is 0.0006425 QALY per protected person-year before geographic attribution. At g=.99, support must cost at most $63.6075 per net protected person-year for $1 m per 10 USA QALYs, or $6.36075 for $100 k per 10.
• At C=$3,927,527, these require P at least 61,746 or 617,463 additional, attributable discounted protected person-years. A five-year protection period has 4.5797 years at 3% year-end discounting: about 13,483 fully attributable continuously protected people reach the first threshold, before any further coalition/funding discount.
• If only 10% of a coalition outcome belongs to ANRF and 50% of marginal funding adds capacity, the same five-year threshold would require roughly 270,000 actual newly protected exposed nonsmokers, assuming full enforcement. This is a planning test, not an observed pipeline.
• Under the same P=10,000 test, removing mortality credit worsens the price to about $227 m per 10; long-term cardiac extrapolation drives most modeled benefit. Younger low-risk cohorts or short-lived policies can be much less valuable.
• A hypothetical added $100 public/employer implementation cost per net protected person-year alone would exceed the $63.61 resource threshold for $1 m per 10. Marginal public costs must therefore be measured separately from the donor-support ratio.
• Adverse enforcement, eviction, displacement and substitution from lower-risk nicotine products can offset benefits in some program branches. No smoking-cessation, cancer or childhood benefit is added without a distinct causal bridge and overlap check.
• Population without comprehensive statutory protection is not identical to workers with measured smoke exposure; do not use the 37.2% coverage complement as the N cohort. Likewise, change in cumulative coverage cannot identify the marginal foundation contribution.

Unresolved inputs

• A prospective next-dollar portfolio budget and specific campaigns/contracts that would shrink or expand with unrestricted funding.
• For each opportunity: exposed nonsmoking residents, baseline age/risk, policy adoption without ANRF, charitable versus lobbying-affiliate contribution, enforcement, survival and acceleration duration.
• Attributable protected person-years per marginal dollar, not cumulative law coverage or policy database use.
• Cost and expected policy/exposure effect of restoring services curtailed after federal funding losses, plus current renewed contracts and flexible reserves.
• US resident versus territory/international health share and worker versus occasional patron exposure.
• Age-specific coronary event risks, utility/lifetime losses, risk-reversal timing and observed displacement/enforcement downsides.
• Additional public/employer implementation costs and any healthcare savings, kept separate from health outcomes.